Individual
MRS. EMILY HEATHERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
175 PHILPOTT LN, BEAVER, WV 25813-9501
(304) 252-9262
Mailing address
2709 GATEWOOD RD, FAYETTEVILLE, WV 25840-5289
(304) 228-1925
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
40588
WV
Other
Enumeration date
08/02/2024
Last updated
08/02/2024
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